Miss Patti’s School of Dance
85 Godwin Ave
Midland Park, NJ 07432
Phone (201) 670-4422 Fax (201) 670-5022

www.misspatti.com

Registration Form

Registration Deposit must accompany this form.

(Please print this form.)

 

Dancer's Name _________________________________ Birth Date _________________

Address ________________________________________________________________

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Phone Numbers (home)________________________ (cell) _________________________

Parent's Name ___________________________________________________________

     Email Address___________________________

     Emergency Number _________________

Class Schedule (Please list 1st and 2nd choices for classes)

AGE as of 9/1/2017
DAY
TIME
 
 
 
 
 
 
 

Comments (Use this space to share any information you feel we need to know about your child, i.e. any medical conditions or special needs.)

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